The drug overdose crisis is about to get a lot worse, and northeast Ohio is unprepared.

There’s a storm coming, and its name is xylazine.

What is xylazine? Also called “tranq dope,” it’s an animal tranquilizer that’s commonly added to opioids like fentanyl to create a longer high. It can cause heart problems, respiratory depression and skin ulcers requiring amputation. Since it’s not an opioid, its effects cannot be reversed with naloxone (though naloxone should always be used for any suspected overdose, as it has no side effects). It’s been on the East Coast for a few years, but the economic incentives of adulterating more expensive drugs have now propelled xylazine across the country. Last month, the White House declared it a threat.

According to The SOAR Initiative, a nonprofit which tracks and sends text alerts for “bad batches” of drugs, xylazine is already here. SOAR recently issued alerts for cocaine mixed with fentanyl in Youngstown and Girard, which caused at least five overdoses. In Ashtabula County, fentanyl-positive crystal meth was found on the scene of two overdoses. Most alarmingly, people who use meth in nearby Wooster are reporting their supply is testing positive for both fentanyl and xylazine.

Imagine going to a bar and ordering an Old Fashioned. But instead of Kentucky bourbon, you get moonshine made in Mexico using grain from China. And there might be some bleach mixed in.

For the 380,000 Ohioans who use illicit substances, this is a daily reality. Ohio’s drug supply is now the most toxic it’s ever been. The result? Over 400 lives lost to preventable overdose every month throughout the state.

The increasing contamination of every black market drug (except cannabis and psychedelics) with fentanyl and now xylazine means that more people than ever are at risk of fatal overdose. That includes the single mother experiencing homelessness who uses meth to stay awake through her 3 jobs, the college freshman experimenting with cocaine or MDMA at a party, and the desperate ADHD patient forced to buy Adderall from the street because they can’t find a pharmacy that stocks it.

So what can we do about it? Fortunately, we know what works — we just need to act.

l- Open a syringe service program (SSP). Despite Mahoning County being an epicenter of the overdose crisis, Youngstown is the largest city in Ohio without an SSP. Valley residents who use drugs need to travel to Akron or Canton to receive their health care. SSPs not only distribute clean supplies, which prevent disease transmission and overdose and decrease the number of discarded needles in public places, they also provide wound care and connect people with substance use disorder to treatment. People can’t seek help if they’re dead, and SSPs play a vital role in keeping people alive until they’re ready to get better.

• Carry naloxone. In the meantime, all of us can do our part as bystanders. Know the signs of an opioid or xylazine overdose: difficulty breathing, decreased heart rate, constricted pupils, blue lips and extremities, unresponsiveness to a sternum rub. Get free naloxone from Harm Reduction Ohio. For xylazine overdoses, perform rescue breathing. If you or someone you know may be using drugs, get fentanyl and xylazine test strips by mail and sign up for bad batch alerts by texting “SOAR” to 330-476-7627.

• Honest education. As a scientist, I believe in harm reduction because it works. But harm reduction is not incompatible with prevention and education. We need to end ineffective, fearmongering, abstinence-only programs like D.A.R.E., and instead be honest with children about the dangers of a contaminated drug supply while empowering them with tools to keep themselves and their friends safe. Organizations like BirdieLight provide free evidence-based drug education for any group of young people. If you’re an educator, administrator, youth group leader, or parent looking to make your community safer, email beth@birdielight.org.

Ohio is set to receive millions of dollars from settlements made by pharmaceutical companies, set to reach local communities by 2024. The time is now for the Mahoning Valley to invest in proven solutions that will save our neighbors’ lives.

Pranav Padmanabhan is a Boardman native, Ohio State University graduate and co-founder and executive board member at The SOAR Initiative. He works as a researcher of substance use at the University of Colorado.